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The whole Materia Medica has been ransacked; yet who can say that there is any thing like a certain remedy for fever?
Blood-letting has had a long and an extensive trial. “There is to be observed, in the practice of all ages, a strong propensity to employ blood-letting in the cure of fevers." In the present day, however, that "propensity” is much diminished. This, Dr. Clutterbuck thinks, is chiefly owing to the influence of hypothesis. “That it has gone so much into disuse in modern times,” says he, “is perhaps more to be ascribed to the influence of hypothesis and speculation than to any direct experience of its ill effects.” If it be as adyantageous, however, in the cure of fever as Dr. Clutterbuck would have us believe, we can only say, that in setting it so much aside the moderns have acted injudiciously. Yet still there must have been some reason why they went a-hunting after new inventions.
The next remedy which our author proposes for fever is vomiting
" No fact in medicine is better ascertained” (says he) “than the power of Emetics in the cure of fevers of every description. Like blood-letting, their efficacy depends much on the earliness of their administration. When given at the very commencement of the symptoms, and before the disease is so fülly formed as to have acquired the force of habit, they often put a sudden and entire stop to its progress; and where they fail of producing this effect, they seem to check the violence of the disease, and mitigate its future symptoms." P. 294.
If “no fact in medicine" be “better ascertained than the power of EMETICS in the cure of fevers of every description," medical facts stand on a very flimsy basis. We have had occasion to see them much employed, and have often employed them ourselves, even at the very commencement of the symptoms” of what is called typhus fever; and we have never seen an instance where they
put a sudden and entire stop to its progress ;” nor did they “seem to check the violence of the disease, and mitigate its future symptoms.” On the contrary, in many cases they evidently increased that violence; and in two instances the energies of the patients sunk immediately after their operation, never to rise again.
The salutary effects which Dr. Clutterbuck ascribes to emetics in fever, he thus explains :
" This effect of emetics is probably in a great measure derived
from their determining powerfully to the surface of the body, and relieving proportionally the internal organs from the force of the circulation.' P. 295.
But while they “deterniine powerfully to the surface of the body," do they not determine as powerfully to the head? Let our author answer this.
“ From theory, the use of emetics in fever might be deemed improper, and even dangerous, from their known tendency to determine the blood with greater violence towards the head; and, in fact, they have been often objected to on this account. No doubt, some caution is necessary in their administration; and experience seems to have ascertained, that they are rendered not only more safe, but more effectual likewise, by previous Joss of blood. But experience has also shown, that they may be safely employed, in a great majority of cases, without such a precaution. Where the action of the heart and arteries is already violent, full vomiting certainly cannot be employed without some degree of hazard; and it has sometimes proved fatal in such cases, by occasioning a rupture of vessels in the brain or other vital organ."
P. 295. Thus, in order to render emetics safe, or to diminish their injurious consequences, we must premise blood-letting; i.l. “where the action of the heart and arteries is already violent.” We are afraid, however, that our author mistakes accelerated for violent action. And is this all thạt can be said in favour of emetics?
" In order to account for the efficacy of emetics in the cure of fever, it is only necessary to advert to the intimate relation that subsists between the brain and stomach, and the influence exerted by each over the other, reciprocally. Let the brain be injured by a shock, or by compression, and the injury is immediately pointed out by nausea and vomiting, almost as clearly as by the disturbance of its own peculiar functions. On the other hand, a state of nausea, any how induced, depresses at once the energy of the brain, and with it that of the whole vascular system.
This is evi, dent in the paleness, coldness, and general feeling of debility, that announce the approach of vomiting, and which sufficiently explain its beneficial influence on inflammation in general, but especially when this disease arises in the brain itself.” P. 293.
Now this is just the very objection that we have to “ nausea,” that it “depresses at once the energy of the brain, and with it that of the whole vascular system;" for the energy of the brain is already deeply depressed. It is this which constitutes the very essence of fever. Raise the febrile patient fron the horizontal to the erect posture, and the same “paleness, coldness, and general feeling of debi
lity that announce the approach of vomiting,” will imme-
The third remedy which Dr. Clutterbuck proposes for
fever is parging
" As being a debilitating remedy, however, purging as well as blood-letting has been in a great measure discarded from modern práctice in fevers. Yet there is much satisfactory evidence to show, that it may be employed with advantage in fevers of various des scriptions, even such as are characterised by great debility, as the low fever or typhus mitior, and remittents.” P. 301.
Our author having adduced the “evidence" to which he
" Some practitioners have denied altogether the utility of purging
when purgatives have been employed after a marked crisis, or after
experience of others, possessed of scarcely inferior means of judging.
Our author sums up the subject in the following
" I may repeat here, with regard to purgatives, what was formerly remarked of blood-letting as a remedy for fever--that there are circumstances of the disease under which they are not only safe, but effectual in carrying it off altogether: we have yet, however, much to learn upon the subject. They may be proper and efficacious at one period of the disease, and hurtful at another; and their use may be limited by a variety of circumstances that are not yet fully understood. Still the general fact recurs, that they do occasionally cure fever: nor do they seem more uncertain in this respect than in the cure of other inflammations." P. 309,
(To be continued.)
Barrow's Account of the Public Life of Lord Macartney.
[Concluded from P. 38 of this Volume.] WE have now to notice his lordship’s literary labours, abstracts of which constitute the second volume of these Memoirs. The first article is an account of Russia in 1767, and displays all that characteristic energy, that sententious brevity of expression, which prove, that however the author might speculatively prefer Livy and Sallust to Tacitus, the latter is the writer whose spirit and manner were most congenial to him. The population of the vast empire of Russia, during our author's embassy, exceeded twenty-eight millions; two of which were burghers, manufacturers, merchants, and mechanics, and only one of farmers : all the others were nobles, slaves, or savages! Since that period, the population has somewhat encreased, and, a few of the serfs, or agricultural slaves, have been enfranchised and become farmers; but the number of savages or “wild nations" has not diminished, nor has civilisation been perceptibly extended Russia, however, in the midst of political disgrace, disaster, and ignominy, has made one great and fortunate conquest, should she be able to retain it; we mean, the university and professors of Abo, in Finland. All the hotbed colleges, academies, and universities, which the autocrats of all the Russias have hitherto been able to establish at Moscow or Petersburgh, cannot be compared with the learned and respect
. able seminary of Abo. Russia, indeed, possesses nothing congenial to learning, arts, and sciences -- no men of learning have ever yet appeared in that country, except some German, Prussian, or Scotch adventurers, who have vainly attempted to enlighten the uncultivated minds of Russian, braggarts, gascons, or boors. No people, who carry gasconade, luxury, and licentiousness to the utmost Íimits of human power, will ever attain any distinguished rank in the scale of rational existence; nor will any government, administered under the caprices and passions of mistresses, ever make a nation happy or prosperous. It is equally certaill, that civilisation cannot be very rapid, in a country where one third of the whole population is in a savage state, one fifth vassals of the crown, and one fourth vassals of the nobles; that is, where nearly the half of all the inhabitants is in a state of slavery, bound to the soil, and sold or bought with it like the houses in which
they dwell; and where the greater part of the remainder leads a wandering and savage life, travelling in families from place to place, like the Arabs. The sketch of the Russian character, although designed nearly forty years ago, will we apprehend be found sufficiently correct, even at the present day. His lordship remarks, that “general portraits are oftener overcharged with the drapery of a rhetorician, than marked by the free and natural ontline of the bistorian and philosopher; yet I am conscious the following picture is not liable to such an inputation.' After observing that the “ great variety of the shades of character which mark the different ranks of people," renders it necessary to divide them into classes; he proceeds:
" The common people, though not laborious, are strong and hardy, patiently bearing the extremes of heat, cold, and hunger to an astonishing degree; yet, il general, they are lazy in body, indolent of mind, and sensual to excess, knowing no happiness beyond the gratifications of drunkenness and gluttony; they are hospitable, charitable, and good-natured; nay, what may seer incredible to a foreigner, they are humane, and can by no means be justly accused of cruelty: the several late revolutions of government in this country are sufficient to plead against such a charge, where so little blood was shed, though the soldiery was let loose, while furious from provocation and thirsty for revenge.
They possess a great deal of natural shrewdness and sagacity, have a strong turn for ridicule, and in their general transactions of business acquit themselves with uncommon cunning and address. The advantages, however, which might arise to the public from their understanding and penetration, are considerably lessened by their superstitious and obstinate attachment to ancient customs, which strangles in its cradle almost every child of improvement or discovery: those few which have arrived to any degree of maturity in this country owe their birth, or at least their education, to foreigners.
" The Russians, however, when properly managed, when soothed by persuasion, allured by profit, or animated by example, become extremely docile, and learn all mechanic arts with surprising facility. They generally pass for being knavish, yet surely they possess a greater share of honesty than we have any right to expect; for, considering the temptations they are exposed to, the abolition of capital punishment, and the little disgrace of successful villany and corruption in the highest ranks of people, it is astonishing that any integrity at all should be found among the commonality.
They are handsome in their persons, easy and unaffected in their behaviour; and, though free and manly in their carriage, are obedient and submissive to their superiors, and of a civility and politeness to their equals which is scarcely to be parallelled. In